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The First Era:

The Second Era. Avedis Donabedian,1980:Structure Process Outcome. . . The Third Era. Brent James,1990:Applying TQM in health careIOM,1999: Direct relationship between quality of care and patient outcome(Patient Safety

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The First Era:

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    1. ??? ???? ?????? ??????

    2. The First Era: Nightingale ,1863: Systematic enquiry of processes Ernest Codman,1910: Variability of outcomes Effectiveness of treatment American college of surgeons,1917: Hospital Standardization Program

    3. The Second Era Avedis Donabedian,1980: Structure Process Outcome

    4. The Third Era Brent James,1990:Applying TQM in health care IOM,1999: Direct relationship between quality of care and patient outcome(Patient Safety…)

    5. A new paradigm (late 80s) because of: Medical errors and nursing negligence Appearance of evidence-based medicine Medical ethics Increasing healthcare costs Nurse physician gap + Complexity in health care organizations

    6. One Error On Every Patient Every Day 6 Dr Mahdavi

    7. Empowerment Keys Knowledge Management Creating autonomy Replacing hierarchy with teams

    9. Accreditation QI Cycle

    10. Accreditation infrastructure Strategic planning Process management Data collection Quality improvement planning Indicators Orientation program Job description Competency testing

    11. Avoid Falsification

    12. Accreditation Precursors Leadership(innovative Organization) Hierarchy To Teambuilding Project Management Change Management Model(e.G: Lewin’s Model) Empowered Learning Model(esp: Common Standards) Focus On Knowledgeables

    13. Public Reporting In late 1980s : case mix _adjusted mortality by CMS))rates In early 1990s: mortality rate on open heart surgery and individual surgeons (angioplasty)

    14. Leader Stays calm when things break down Adapts smoothly to changing situations Willing to delegate authority Refuses to micromanage Is always positive and optimistic

    15. Leader Employs a “big picture” – yet contextualized – approach Succinctly explains “mission, standards and priorities.” Maintains the highest ethical standards and insists that others do the same Promotes a sense of teamwork throughout the organization

    16. Leader Recognizes that a “zero-defects mentality” is unrealistic Allows others to fail Listens well Communicates well(tongue ,ear ,brain ,heart , Circumstances) Displays high level of optimism ,confidence and positive thinking Is patient

    17. Leader Has a sense of humor(and welcome to criticism) Is initiative Is transparent Develops leaders around him/her Uses good word Has abundance mentality(not scarcity mentality)

    18. ?? ????

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